September 29, 2022
Today I want to talk about a topic that often gets brought up in consultations or pre-consultations: the cost of bariatric surgery.
This is a crucial topic to discuss because most people feel that bariatric surgery is out of their means financially, but what you don’t realize is that most insurance companies cover bariatric surgery.
So let’s start with insurance.
Most insurance companies do cover bariatric surgery. In fact, in the state of Arizona, all government plans are required to at least offer a bariatric surgical option. So if you are on a government plan, most of the time, you will have the opportunity for bariatric surgery.
You may have bariatric coverage benefits, but you haven’t chosen them.
So in our practice, when someone signs up for an appointment or gives us a call, we always verify their benefits ahead of time because what we don’t want is for someone to have a surprise cost. So when we verify benefits, we notify the patient if they do or do not have bariatric coverage.
If you don’t have coverage, I recommend that you first call your insurance company or go to your human resources department because it may be that you have not chosen bariatric benefits. You may have the opportunity to change your plan during the open enrollment period, which would then cover the cost of bariatric surgery.
What do I mean when I say your insurance will cover your visits?
Like any other doctor’s appointment, your bariatric coverage will cover everything except your deductible and copays, which will be your responsibility.
Most patients pay copays to specialists, including the pulmonologist, the cardiologist, the psychologist, et cetera. And by the time they reach their surgery, much of their deductible has been paid, or they have other medical conditions that cover that.
Now let’s talk about cash pay. Cash pay options vary widely depending on where you go, your surgery, and whether you’re in a surgical center or a hospital.
These numbers will vary depending on where you are and what procedure you have done. When choosing a procedure for bariatric surgery, it should be based on your medical history and your medical conditions, not the price of surgery.
The least expensive option I currently offer in my practice is an outpatient sleeve gastrectomy. We offer this for roughly $10,000, including everything – anesthesia, facility fees, et cetera.
When we do a same-day discharge sleeve gastrectomy in the hospital, the price is roughly 15,000. This is the only procedure I offer as outpatient same-day discharge.
When we include an observational stay, meaning you have your procedure, you stay one night overnight, and you go home sometime midday the next day. The sleeve gastrectomy in that setting is roughly $15,000. A modified duodenal switch procedure, or a SIPS, is approximately $17,000, and a Roux-En-Y gastric bypass is approximately $18,000.
Sometimes, the length of stay is greater than one overnight. This happens when patients either have reactions to anesthesia, if there’s a complication, or if they’re not meeting their goals of walking, hydrating, et cetera, as assessed by the medical team. In this situation, when you’re in the hospital for more than one night’s stay, a sleeve gastrectomy is roughly $17,000. The two-day stay price for a modified switch procedure is approximately $19,000. And for Roux-En-Y gastric bypass, the cost is about 20,000.
It is important to remember when you are setting yourself up for these surgeries, especially when you’re paying out of pocket – which is a small number of people – no one can ever guarantee you that you’ll have outpatient surgery. No surgeon can predict how the surgery will go. While complication rates are extremely low in bariatric surgery, no one can guarantee that there won’t be a complication. No one can ensure that your reaction to anesthesia will be amenable to going home that day. So it’s always important to remember that while your anticipation may be outpatient, you may stay overnight or for an extended stay, depending on how you and your body react to the operation.
I hope that this information is helpful for you in making your decisions.
The cost of surgery far outweighs the cost of living a life with so many medical comorbidities, saving over $2,000 a year per patient in medical costs. But that is a decision that only you can make in your individual life and your financial situation.
What’s most important, and I cannot emphasize enough, is that the surgery you choose should be based on what is the best medical fit for you, not the price of the surgery. Otherwise, you may find yourself in a situation where you require another surgery in the future – whether it’s for weight regain or severe heartburn for getting a sleeve when a gastric bypass is more appropriate.
Cost does vary very widely, but there are a lot of options. Additionally, some centers have options for financing, such as care credit and financing through the hospital itself if you find yourself paying cash. And then lastly, many hospital centers offer a discounted rate for someone who is paying cash. Inquire about those things when you’re seeking a surgeon or a surgical intervention. And if you have further questions and want to talk to a surgeon, please call us.
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